Provider Demographics
NPI:1518613488
Name:HUNT CLUB FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:HUNT CLUB FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-870-9524
Mailing Address - Street 1:1509 HUNT CLUB BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6049
Mailing Address - Country:US
Mailing Address - Phone:615-452-6765
Mailing Address - Fax:
Practice Address - Street 1:1509 HUNT CLUB BLVD STE 800
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6049
Practice Address - Country:US
Practice Address - Phone:615-452-6765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental